Transcarotid Neurovascular Catheter

ABSTRACT

An interventional catheter for treating an artery includes an elongated body sized and shaped to be transcervically introduced into a common carotid artery at an access location in the neck. The elongated body has an overall length such that the distal most section can be positioned in an intracranial artery and at least a portion of the proximal most section is positioned in the common carotid artery during use.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. application Ser. No.15/050,039 filed Feb. 22, 2016 entitled “Transcarotid NeurovascularCatheter”, which is a Continuation of U.S. application Ser. No.14/569,365 filed Dec. 12, 2014, now U.S. Pat. No. 9,265,512 issued onFeb. 23, 2016 entitled “Transcarotid Neurovascular Catheter”, whichclaims priority to: (1) U.S. Provisional Application Ser. No. 62/029,799filed Jul. 28, 2014; (2) U.S. Provisional Application Ser. No.62/075,101 filed Nov. 4, 2014; (3) U.S. Provisional Application Ser. No.62/046,112 filed Sep. 4, 2014; and (4) U.S. Provisional Application Ser.No. 62/075,169 filed Nov. 4, 2014; (5) U.S. Provisional Application Ser.No. 61/919,945 filed Dec. 23, 2013; and (6) U.S. Provisional ApplicationSer. No. 62/083,128 filed Nov. 21, 2014. The provisional patentapplications are all incorporated by reference in their entirety andpriority to the filing dates is claimed.

BACKGROUND

Intravascular catheters are used to access target vascular regions fromremote vascular access sites to perform a procedure. The design,materials, and construction of particular catheters are primarilydirected to allow the catheter to reach the target vascular anatomywhile not causing vessel trauma, as well as to perform the catheter'sintended function upon the catheter reaching the target anatomy. Thecatheter often has multiple requirements that may conflict with oneanother. Consequently, a strong design optimally balances the goals ofthese requirements.

Many catheters are single lumen catheters wherein the lumen acts as achannel for the delivery of radiopaque or therapeutic agents or forother interventional devices into the blood vessel, and/or foraspiration of blood, thrombus, or other occlusive material out of theblood vessel. Such catheters have physical properties that allow them tobe advanced through a vessel access site from a proximal end intovascular anatomy which is often very curved, delicate, tortuous, andremote from the blood vessel access site. These catheters are alsodesigned to be used with adjunctive devices such as guide wires andsometimes smaller catheters positioned in the inner lumen, and to bedirected to the target anatomy through vascular access sheaths, guidecatheters and sometimes sub-selective guide catheters (i.e. cathetersthat are specifically designed to go to more distal locations thantypical guide catheters). In other words, it is often not a singlecatheter but a system of catheters, guide wires, guide catheters, andsheaths that allows the user to adequately perform an intendedprocedure.

Interventions in the cerebral vasculature often have special accesschallenges. Most neurointerventional procedures use a transfemoralaccess to the carotid or vertebral artery and thence to the targetcerebral artery. However, this access route is often tortuous and maycontain stenosic plaque material in the aortic arch and carotid andbrachiocephalic vessel origins, presenting a risk of emboliccomplications during the access portion of the procedure. In addition,the cerebral vessels are usually more delicate and prone to perforationthan coronary or other peripheral vasculature. In recent years,interventional devices such as wires, guide catheters, stents andballoon catheters, have all been scaled down and been made more flexibleto better perform in the neurovascular anatomy. However, manyneurointerventional procedures remain either more difficult orimpossible because of device access challenges. In some instances, adesired access site is the carotid artery. Procedures in theintracranial and cerebral arteries are much closer to this access sitethan a femoral artery access site. Importantly, the risk of emboliccomplications while navigating the aortic arch and proximal carotid andbrachiocephalic arteries are avoided. However, because most cathetersused in interventional procedures are designed for a femoral accesssite, current devices are not ideal for the alternate carotid accesssites, both in length and mechanical properties. This makes theprocedure more cumbersome and in some cases more risky if using devicesdesigned for femoral access in a carotid access procedure.

U.S. Pat. No. 5,496,294 (the '294 patent) describes a single lumen,three-layer catheter design, including (1) an innerPolytetrafluoroethylene (PTFE) liner to provide a low-friction innersurface; (2) a reinforcement layer formed of a metal coil wire or coilribbon; and (3) an outer jacket layer. Typically, the three layers arelaminated together using heat and external pressure such as with heatshrink tubing. The catheter has multiple sections of varying stiffnesssuch that flexibility increases moving towards the distal end of thecatheter. This variation in flexibility may be accomplished by varyingthe durometer of the outer jacket layer along the length of thecatheter. Another method to vary flexibility is by varying thereinforcement structure and/or material along the length of thecatheter.

One limitation in the '294 patent and in other existing neurovascularcatheter technology is that the devices are designed for a femoralaccess approach to the cerebral arteries. The pathway from the femoralartery to the common carotid artery and thence to the internal carotidartery is both long and comprises several back and forth bends. Thedimensions provided in the '294 patent are consistent with this designgoal. However, catheters designed to navigate this route have lengthsand flexibility transitions that would not be appropriate for atranscarotid access, and would in fact detract from performance of atranscarotid catheter. For example the flexible sections must be atleast 40 cm of gradually increasing stiffness from the distal end to aproximal-most stiff section, to be able to navigate both the internalcarotid artery curvature and the bends required to go from the aorticarch into the common and then the internal carotid artery.

Another disadvantage to the catheter construction described in the '294patent is the catheter's limited ability to have continuous, smoothtransitions in flexibility moving along its length. There are discreetdifferences in flexibility on a catheter where one jacket material abutsanother, or when one reinforcement structures abuts anotherreinforcement structure. In addition, the tri-layer catheterconstruction of the '294 patent has limitations on the wall-thicknessdue to the need to be able to handle and assemble the three layers ofthe catheter during manufacture. In addition, the catheter constructionmakes it difficult to have a relatively large inner lumen diameter whilemaintaining properties of flexibility and/or kink resistance to verysharp bends in the blood vessel. As a general rule, the larger diametercatheters also tend to be stiffer in order to remain kink resistant.

SUMMARY

There is a need for a catheter with dimensions and mechanical propertieswhich have been optimized to access the cerebral vessels from a carotidartery access site. There is also a need to for a catheter that hasgradual, smooth transitions from a first flexibility to at least asecond, different flexibility moving along the length of the catheter.There is also a need for a catheter that has a relatively large innerdiameter compared to prior art catheters, and yet is able to maintainphysical properties such as thin wall thickness, kink resistance andflexibility.

Disclosed is an intravascular catheter that that has been optimized foraccessing anterior cerebral vessels from a carotid artery access site.

Disclosed also is a catheter which includes variations in flexibility orstiffness moving along at the entire length of catheter or a portion ofthe length of the catheter. Advantageously, the change in flexibility ofthe catheter is represented by smooth, rather than sudden, changes inflexibility. In other words, the flexibility of the catheter transitionsgradually moving along its length without any sudden or discretevariations in flexibility from one section of the catheter to anadjacent section of the catheter. As described in more detail below, thecatheter can be particularly sized and shaped according to how thecatheter will be used and in what particular section of the vascularanatomy the catheter will be used.

Also disclosed is an interventional catheter for treating an artery,comprising: an elongated body sized and shaped to be transcervicallyintroduced into a common carotid artery at an access location in theneck, the elongated body sized and shaped to be navigated distally to anintracranial artery through the common carotid artery via the accesslocation in the neck; an internal lumen in the elongated body, theinternal lumen forming a proximal opening in a proximal region of theelongated body and a distal opening in a distal region of the elongatedbody; wherein the elongated body has a proximal most section and adistal most section wherein the proximal most section is a stiffestportion of the elongated body, and wherein the elongated body has anoverall length and a distal most section length such that the distalmost section can be positioned in an intracranial artery and at least aportion of the proximal most section is positioned in the common carotidartery during use.

Other features and advantages should be apparent from the followingdescription of various embodiments, which illustrate, by way of example,the principles of the disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A shows a schematic view of an exemplary catheter.

FIG. 1B shows a schematic view of an alternate embodiment of a catheter.

FIGS. 2-5 show examples of catheters having angled distal tips or distaledges.

FIG. 6 illustrates an embodiment of a catheter with a tapered co-axialinner member.

FIG. 7 illustrates another embodiment of a catheter with a taperedco-axial inner member.

DETAILED DESCRIPTION

FIG. 1A shows a schematic view of an exemplary catheter 105. Thecatheter 105 is an elongated body that has an external dimension that issized and shaped for insertion into a blood vessel. In an embodiment,the catheter 105 is sized and shaped for insertion into an access sheathof a carotid artery access system such as described in U.S. patentapplication Ser. No. 12/834,869 entitled SYSTEMS AND METHODS FORTREATING A CAROTID ARTERY, which is incorporated by reference herein inits entirety. U.S. patent application Ser. No. 14/537,316 entitledMETHODS AND DEVICES FOR TRANSCAROTID ACCESS and filed Nov. 10, 2014 isalso incorporated herein by reference in its entirety. The proximalregion of the catheter 105 may have one or more mechanical orelectro-mechanical control mechanisms for controlling differentcomponents on or near a distal end of the catheter 105. For example, thecontrol mechanism(s) can be used to control inflation of a balloon orballoons, advancement/deployment of a system component (such as astent), flushing or aspirating a fluid through the catheter, andcombinations thereof.

With reference again to FIG. 1A, the catheter 105 is configured to beinserted through an access sheath in the carotid artery and navigateddistally to the distal ICA or cerebral vessels. A proximal port 2035with a hemostasis valve may be situated on the proximal end of catheter105, to allow introduction of devices such as a microcatheter, guidewire, stent delivery device, aneurysm coil delivery device, orthrombectomy device while preventing or minimizing blood loss during theprocedure. The hemostasis valve may be integral to the catheter proximaladaptor, or may be removably attached to the proximal end of thecatheter via a proximal connector. In an embodiment, this valve is anadjustable-opening valve such as a Tuohy-Borst or rotating hemostasisvalve (RHV). In another embodiment, the valve is a passive sealhemostasis valve.

The catheter 105 may be made with a two or more layer construction. Inan embodiment, the catheter has a PTFE inner liner, an outer jacketlayer, and at least a portion of the catheter has a reinforcementstructure, such as a tubular structure formed of, for example, a woundcoil, braid or cut hypotube. In addition, the catheter may have aradiopaque marker at the distal tip to facilitate placement of thedevice using fluoroscopy.

The catheter 105 has an insertable portion (or working length) that issized to be inserted through an access sheath in the carotid artery andpassed through an arterial pathway (through the artery) to the distalICA or cerebral vessels. In an embodiment adapted to be used with anaccess sheath of total length including the sheath hemostasis valve ofabout 15 to 20 cm, the catheter 105 has a working length ranging from 40to 70 cm. The working length (or insertable portion) of the catheter isthe portion of the catheter that is sized and shaped to be inserted intothe artery and wherein at least a portion of the working length isactually inserted into the artery during a procedure. In an embodiment,the catheter has a working length of less than 70 cm, less than 60 cm,or less than 50 cm. A similar catheter designed for a transfemoralaccess site may have a working length of between 100 and 130 cm.Alternately, the length of catheter can be defined relative to thelocation of the access site and the target cerebral artery site. In anembodiment, the catheter is configured to be introduced into the arteryat a location in the artery that is less than 40 cm, less than 30 cm, orless than 20 cm from the location of the target site as measured throughthe arterial pathway. The distance may further be defined by a ratio ofworking length to the distance between the location where the catheterenters the arteriotomy and the target site. In an embodiment, this ratiois less than 2×. In an embodiment, the working length of the device mayhave a hydrophilic coating to improve the ease of advancement of thedevice through the vasculature. In an embodiment, at least 40% of theworking length of the catheter is coated with a hydrophilic material. Inother embodiments, at least 50% or at least 60% of the working length ofthe catheter is coated with a hydrophilic material. In an embodiment,the elongated body has an overall length and a distal most section orportion length such that the distal most section can be positioned in anintracranial artery and at least a portion of the proximal most section115 (FIG. 1A) is positioned in the common carotid artery during usewhile transcervically inserted into the common carotid artery.

In an embodiment, the distal-most section 111 (FIG. 1A) is constructedto be more flexible than the proximal portion, with one or more flexiblesections, to successfully navigate the internal carotid artery curvatureto reach target sites in the distal (internal carotid artery) ICA orcerebral arteries. The shaft may have a transition, or intermediate,section 113 of one or more increasingly stiff sections towards the moreproximal section of the shaft, with the proximal most portion having thestiffest shaft section. Alternately, the transition section is a sectionof continuously variable stiffness from the distal section stiffness tothe proximal section stiffness. In an embodiment, the distal mostflexible section is between 5 and 15 cm. In another embodiment, thedistal most flexible section is between 3 and 10 cm. In anotherembodiment, the distal section is between 2 and 7 cm. In an embodiment,the transition section is between 5 and 15 cm. In another embodiment,the transition section is between 5 and 10 cm. In another embodiment,the transition section is between 4 and 8 cm. In all these embodiments,the proximal-most stiff section takes up the remainder of the workinglength. In an embodiment where the catheter has a working length of 40cm, the proximal-most stiff section is in a range 10 to 30 cm. In anembodiment where the catheter has a working length of 70 cm, theproximal-most stiff section is in a range from 40 to 60 cm. In anembodiment, the stiffest portion of the catheter is the proximal mostportion of the catheter. The catheter can have a length such that, wheninserted into the common carotid artery via a transcarotid entryway intothe artery, the stiffest section of the catheter is located at leastpartially within the common carotid artery or can be positioned at leasttwo centimeters into the common carotid artery. In an embodiment, thecatheter has a length such that at least portion of the proximal mostsection is positioned in the common carotid artery when the distal mostsection is in an intracranial artery during use. The relative lengths ofdistal most section, transition section, and proximal most sections arenot necessarily shown to scale in FIG. 1A.

Alternately, the flexible distal section and transition section may bedescribed as a portion of the overall catheter working length. In anembodiment, the flexible distal most section is between 3 to 15% of thelength of the working length of the catheter. In another embodiment, theflexible distal most section is between 4 and 25% of the length of theworking length of the catheter. Similarly, in an embodiment, thetransition section is between 7 and 35% of the length of the workinglength of the catheter. In another embodiment, the transition section isbetween 6 and 20% of the working length of the catheter.

In an embodiment, the flexibility of the distal most section is in therange 3 to 10 N-mm² and the flexibility of the proximal post section isin the range 100 to 500 N-mm², with the flexibility/flexibilities of thetransition section falling between these two values.

As noted above, the catheter may have sections with discreet and/orcontinuously variable stiffness shaft. The sections of varyingflexibility may be achieved by multiple methods. For example, the outerjacket layer may be composed of discreet sections of polymer withdifferent durometers, composition, and/or thickness. In anotherembodiment, the outer layer has one or more sections of continuouslyvariable outer layer material that varies in flexibility. The cathetermay be equipped with the continuously variable outer layer material bydip coating the outer layer rather than laminating a jacket extrusiononto a PTFE-liner and reinforcement assembly of the catheter. The dipcoating may be, for example, a polymer solution that polymerizes tocreate the outer jacket layer of the catheter. The smooth transitionfrom one flexibility (e.g., durometer) to another flexibility along thelength of the catheter can be accomplished via dipping the catheterassembly in multiple varying durometer materials whereby the transitionfrom one durometer to another can be accomplished in a graded pattern,for example by dipping from one side of the catheter in one durometerwith a tapering off in a transition zone, and dipping from the otherside in another durometer with a tapering off in the same transitionzone, so there is a gradual transition from one durometer to the other.In this embodiment, the dip coating can create a thinner walled outerjacket than a lamination assembly. In another embodiment, the catheterhas an outer jacket layer that is extruded with variable durometer alongthe length, to provide variable flexibility along the length of thecatheter.

In an embodiment, at least a portion of the catheter has a reinforcementstructure, such as a tubular structure formed of, for example, a woundcoil, braid that is composed of discreet or continuously varyingstructure to vary the stiffness, for example a variable coil or braidpitch. In an embodiment, the reinforcement structure is a cut hypotube,with a cut pattern that is graded along the length, for example cut in aspiral pattern with continuously variable pitch or continually variablecut gap, or a repeating cut pattern that allows the tube to flex wherebythe repeating pattern has a continuously variable repeat distance orrepeat size or both. A cut hypotube-reinforced catheter may also havesuperior pushability than a coil-reinforced catheter, as it is astructure with potentially greater stability in the axial direction thana wound coil. The material for the reinforcement structure may bestainless steel, for example 304 stainless steel, nitinol, cobaltchromium alloy, or other metal alloy that provides the desiredcombination of strengths, flexibility, and resistance to crush. In anembodiment, the reinforcement structure comprises multiple materialsalong the different sections of flexibility

In another embodiment the catheter has a PTFE inner liner with one ormore thicknesses along variable sections of flexibility. In anembodiment, the PTFE inner liner is constructed to be extremely thin,for example between 0.0005″ and 0.0010″. This embodiment provides thecatheter with a high level of flexibility as well as the ability toconstruct a thinner-walled catheter. For example, the PTFE liner isconstructed by drawing a mandrel through a liquid PTFE liquid solutionrather than the conventional method of thin-walled PTFE tubingmanufacture, namely extrusion of a PTFE paste which is then dried andsintered to create a PTFE tube. The draw method allows a very thin andcontrolled wall thickness, such as in the range of 0.0005″-0.0010″.

Any one of the aforementioned manufacturing methods may be used incombination to construct the desired flexibility and kink resistancerequirement. Current tri-layer catheters have wall thicknesses rangingfrom 0.005″ to 0.008″. These manufacturing techniques may results in acatheter with better catheter performance at the same wall thickness, orwith equal or better catheter performance at lower wall thicknesses forexample between 0.003″ to 0.005″.

In an embodiment, the distal flexible section of the catheter may beconstructed using one or more of: a dip coated outer layer, an extremelythin drawn PTFE layer, and a cut hypotube reinforcement layer, with agradual transition from the flexible section to a stiffer proximalsection. In an embodiment, the entire catheter is constructed with oneor more of these elements

In some instances, there is a need to reach anatomic targets with thelargest possible internal lumen size for the catheter. For example thecatheter may be used to aspirate an occlusion in the blood vessel. Thusthere is a desire to have a very flexible, kink resistant and collapseresistant catheter with a thin wall and large inner diameter. A catheterusing the construction techniques disclosed herein meets theserequirements. For example, the catheter may have an inner diameter of0.068″ to 0.095″ and a working length of 40-60 cm. In anotherembodiment, the catheter may be sized to reach the more distal cerebralarteries, with an inner diameter of 0.035″ to 0.062″ and a workinglength of 50-70 cm. In an embodiment, the catheter is configured tonavigate around a 180° bend around a radius as small as 0.050″ or 0.100″without kinking, wherein the bends are located within 5 cm, 10 cm, or 15cm of the arteriotomy measured through the artery. In an embodiment, thecatheter can resist collapsing whilst in a tortuous anatomy up to180°×0.050″ radius bend without collapsing when connected to a vacuum upto 20 inHg. In an embodiment, the catheter can resist collapse in thesame conditions when connected to a vacuum up to 25 inHg.

In another embodiment shown in FIG. 1B, the inner and outer diameter maybe stepped up at a proximal region 107 of the catheter. The step upcorresponds to an increase in diameter relative to an adjacent region ofthe catheter. This embodiment would further optimize the aspirationpower of the catheter. For example, the portion of the catheter which isin more proximal, larger vessels during a procedure may have a largerdiameter than distal region 109 of the catheter, which can be the distalmost region. In this embodiment, the catheter may have a diameter forthe region 109 (such as the distal most 10-15 cm), then have a step upin diameter of between 10-25% of the distal most diameter for theproximal region 107 of the working length. The step up would occur overa tapered transition section between 3 and 10 mm in length, depending onthe size of the step up and the need to make a smooth transition.Alternately, the catheter is used with a stepped sheath with a largerdiameter proximal region. In this case, the catheter may be stepped up alength and diameter to match the stepped sheath. For example, if thesheath has a portion with larger diameter for the proximal 20 cm of thesheath, the catheter would have a larger diameter for the proximal 25 cmto allow for additional length through proximal adaptors and valves suchas an RHV. The remaining distal region would have a smaller diameter,with a step up over a tapered transition section between 3 and 10 mm inlength, depending on the size of the step up and the need to make asmooth transition

In some instances, a neurovascular catheter is used to aspirate clot orother obstruction in a cerebral or intracranial vessel. FIGS. 2-5 showexamples of catheters having angled distal tips or distal edges. Withreference to FIG. 2, the distal region of a catheter 105 is shown. Thecatheter 105 has a distal-most tip or edge 210 that forms an opening 215at the distal end of the catheter 105. The distal edge 210 forms anangle that is non-perpendicular relative to the longitudinal axis L.Such a tip defines a different sized opening 215 than if the tip wereperpendicular to the axis L. That is, the opening 215 is larger andpresents a larger suction area relative to a distal tip that is cutnormal to the longitudinal axis. The catheter therefore may provide alarger suction force on the occlusion located near the tip. The largerarea opening 215 also facilitates suctioning the clot into the lumen ofthe catheter, rather than just capturing the clot at the tip withsuction force and pulling back the captured clot with the catheter. InFIG. 2, the catheter 105 has an angled, straight edge 210 creating anelliptical opening 215. In FIGS. 3, 4 and 5, the distal edge 210 iscurved or non-straight such that the distal opening 215 is non-planarand may offer greater opening without extending the tip length out asmuch, which may optimize the contact area with the occlusion further.The distal edge 210 may be straight, curved, undulating, or irregular.In an embodiment with a cut hypotube-reinforced catheter, the distal tipof the hypotube can be formed with the non-square shape. In anembodiment with a radiopaque marker band, the radiopaque marker band mayhave a non-square edge which can then be used to create the non-squarecatheter tip shape. In an embodiment, the catheter may have an angleddistal tip. That is, the distal tip of the catheter is angled ornon-perpendicular relative to a longitudinal axis of the catheter.

A cause of difficulty in advancing catheters through severe bends andacross side branches is the mismatch between the catheter and the innerguiding components such as smaller catheters, microcatheters, orguidewires. One technique for advancing a catheter is called a tri-axialtechnique in which a smaller catheter or microcatheter is placed betweenthe catheter and the guide wire. However, with current systems thesmaller catheter has a diameter mismatch between either the largercatheter, the guide wire, or both, which creates a step in the system'sleading edge as the system is advanced in the vasculature. This step maycause difficulty when navigating very curved vessels, especially at alocation where there is a side-branch, for example the ophthalmicartery. In an embodiment, as shown in FIG. 6, the catheter 105 issupplied with a tapered co-axial inner member 2652 that replaces thesmaller catheter generally used. The inner member 2652 is sized andshaped to be inserted through the internal lumen of the catheter. Theinner member 2652 has a tapered region with an outer diameter that formsa smooth transition between the inner diameter of the catheter 2030 andthe outer diameter of a guidewire 2515 or microcatheter that extendsthrough an internal lumen of the inner member 2652. In an embodiment,the tapered dilator or inner member 2652, when positioned within thecatheter, creates a smooth transition between the distal-most tip of thelarger catheter 105 and the outer diameter of a guide wire 2515 whichmay be in the range of 0.014″ and 0.018″ diameter for example. Forexample, the inner luminal diameter may be between 0.020″ and 0.024″. Inanother embodiment, the inner diameter is configured to accept amicrocatheter with an outer diameter in the range of 0.030″ to 0.040″ oran 0.035″ guide wire in the inner lumen, for example the inner luminaldiameter may be 0.042″ to 0.044″.

In a variation of this embodiment, shown in FIG. 7, in addition to thetapered region, the inner member 2652 includes an extension formed of auniform diameter or a single diameter, distal-most region 2653 thatextends distally past the tapered portion of the inner member 2652. Inthis embodiment the distal region 2653 of the inner member 2652 mayperform some or all of the functions that a microcatheter would doduring an interventional procedure, for example cross an occlusion toperform distal angiograms, inject intraarterial agents, or deliverdevices such as aneurysm coils or stent retrievers. In this manner, amicrocatheter would not need to be exchanged for the dilator for thesesteps to occur.

The material of the dilator (inner member 2652) is flexible enough andthe taper is long enough to create a smooth transition between theflexibility of the guide wire and the catheter. This configuration willfacilitate advancement of the catheter through the curved anatomy andinto the target cerebral vasculature. In an embodiment, the dilator isconstructed to have variable stiffness, for example the distal mostsection is made from softer material, with increasingly harder materialstowards the more proximal sections. In an embodiment, distal end of thetapered dilator has a radiopaque marker such as a platinum/iridium band,a tungsten, platinum, or tantalum-impregnated polymer, or otherradiopaque marker.

Although embodiments of various methods and devices are described hereinin detail with reference to certain versions, it should be appreciatedthat other versions, embodiments, methods of use, and combinationsthereof are also possible. Therefore the spirit and scope of theappended claims should not be limited to the description of theembodiments contained herein.

1-19. (canceled)
 20. A method of treating an artery, comprising:introducing an interventional catheter formed of elongated body into acommon carotid artery via an access location in a neck, the elongatedbody sized and shaped to be introduced into the common carotid artery atthe access location in the neck, wherein the elongated body includes aninternal lumen forming a proximal opening in a proximal region of theelongated body and a distal opening in a distal region of the elongatedbody, and wherein the elongated body has a proximal most section and adistal most section wherein the proximal most section is a stiffestportion of the elongated body and wherein the elongated body has anoverall length and a distal most section length such that the distalmost section can be positioned in an intracranial artery and whilesimultaneously at least a portion of the proximal most section ispositioned in the common carotid artery during use;: (a) wherein thedistal most section of the catheter has an inner diameter of 0.068 to0.095 inch; (b) wherein the catheter can navigate around a 180° bendwith a radius of 0.100″ without kinking; (c) wherein the catheter doesnot collapse when connected to a vacuum up to 25 inHg while navigatingaround a 180° bend with a radius of 0.100″; navigating the elongatedbody distally to an intracranial artery through the common carotidartery.
 21. A method as in claim 20, wherein the elongated body includesa first transition section between the proximal section and the distalmost section, and wherein the transition section has a stiffness betweena stiffness of the proximal most section and the distal most section.22. A method as in claim 20, wherein the elongated body has a workinglength and wherein the distal most section is between 3% and 15% of thelength of the working length of the elongated body.
 23. A method as inclaim 20, wherein the elongated body has a working length and whereinthe distal most section is between 4% and 25% of the length of theworking length of the elongated body.
 24. A method as in claim 21,wherein the first transition section is between 7 and 35% of the lengthof the working length of the catheter.
 25. A method as in claim 21,wherein the first transition section is between 6 and 20% of the lengthof the working length of the catheter.
 26. A method as in claim 22,wherein the elongated body has an inner diameter of 0.068″ to 0.095″ anda working length of 40-60 cm.
 27. A method as in claim 22, wherein theelongated body has an inner diameter of 0.035″ to 0.062″ and a workinglength of 50-70 cm
 28. A method as in claim 20, wherein the elongatedbody varies in stiffness moving along at least a portion of the lengthof catheter.
 29. A method as in claim 9, wherein the variation instiffness is represented by smooth change in flexibility without anysudden changes in flexibility.
 30. A method as in claim 9, wherein theflexibility of the elongated body transitions gradually moving along itslength without any discrete variations in flexibility from one sectionof the elongated body to an adjacent section of the elongated body. 31.A method as in claim 20, wherein the proximal most section has astiffness in the range of 100 to 500 N-mm2.
 32. A method as in claim 20,wherein the distal most section has a stiffness in the range of 3 to 10N-mm2.
 33. A method as in claim 20, wherein the distal most section isbetween 5 and 15 cm in length.
 34. A method as in claim 20, wherein thedistal most section is between 3 and 10 cm in length.
 35. A method as inclaim 21, wherein the first transition section is between 5 and 10 cm inlength.
 36. A method as in claim 21, wherein the first transitionsection is between 4 and 8 cm in length.
 37. A method as in claim 20,wherein the elongated body has a working length of 40 cm and theproximal most section has a length of 10 to 30 cm.
 38. A method as inclaim 20, further comprising inserting an inner member inside theinternal lumen of the elongated body, the inner member having a taperedleading edge.